Provider Demographics
NPI:1104934538
Name:CHUNG MORITA, JONIE (DC)
Entity type:Individual
Prefix:DR
First Name:JONIE
Middle Name:
Last Name:CHUNG MORITA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 S DIAMOND BAR BLVD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2203
Mailing Address - Country:US
Mailing Address - Phone:909-860-1661
Mailing Address - Fax:909-860-0125
Practice Address - Street 1:1241 S. GRAND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765
Practice Address - Country:US
Practice Address - Phone:909-860-1661
Practice Address - Fax:909-860-0125
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU99601Medicare UPIN
CAWDC28353BMedicare ID - Type Unspecified
CAWDC28353AMedicare ID - Type UnspecifiedMEMBER ID